Human development

Developmental psychologists have tended to divide up the human life span into the following three categories. Most books on human psychological development use this breakdown.

One can portray human development as a series of hurdles of tasks that the person must jump over or master. For example in childhood the child has to learn to walk, talk, be toilet trained, deal with the oedipus complex, go to school and so on. They need to go through all the stages of cognitive development and moral development and so on. A child goes through a period of significant and quite fast physical change and psychological change.

One can say the same applies for the teenager. They have a whole series of hurdles to jump or tasks to master. They also have to go through a series of cognitive and moral development stages, learn how to engage with the opposite sex, develop a social support system with their peers and so forth. Like in childhood they go through a period of quite fast and significant physical and psychological development.

Developmental psychologist have decided to make a separation between the stages of childhood and adolescence. This corresponds with the age about when puberty starts. For some reason at this point they say a person has moved onto a new stage of psychological development. They distinguish between the psychological stage of childhood and the psychological stage of adolescence as occurring when puberty arrives.

To my mind this is an arbitrary distinction which is a nonsense and I have not heard of the rational for doing this. One could argue that this distinction needs to be made because the developmental tasks required in childhood are significantly different than the developmental tasks required in adolescence. This is a hypothesis with which I would agree. Without a doubt a 4 year old child is dealing with very different developmental issues than a 14 year old teenager. However the choice of 12 or 13 years of age for the new developmental stage to arrive seems quite a random decision to make.

It can also be argued that a 2 year old child and an 8 year old child are very different physically and the psychological developmental issues they are dealing with are also quite different. So why not conclude that they are two separate developmental stages instead of including them in the same developmental stage as is currently the case. The same of course applies for a 13 year old and the 18 year old. At the moment they are in the same developmental stage but they are also quite different physically and psychologically. Why are they not defined as two separate developmental stages?

One can really see the two stages of childhood and adolescence as one developmental stage. In both stages the young person is going through significant and rapid physical and psychological change. Whereas in adulthood this is not the case. Yes there is indeed physical and psychological change occurring in adulthood but it can be seen as much slower and less psychologically significant. Thus there is much more focus on the younger person as this is where more of the difficulties can occur if the development is not occurring as it should. Developmental psychology is about developmental change in the person so one could see the human life cycle in a different way. Divided up into phases where there is a lot of psychological change occurring and not.

In this model pre-adulthood (childhood and adolesence) is seen as a phase of significant physical and psychological development. Adulthood is a phase of much less significant physical and psychological development. At the end of life we have another developmental stage, Post-adulthood. One could say this stage begins in the late 50s or 60s. In this period there is significant physical change as the body again moves into such a phase of change. These changes can have significant consequences including major disability, deformity or death. These changes force the person into significant psychological change as they accept, or seek to deny, the consequences of such change and acceptance of their bodily changes. With the physical changes the person has to change their perception of them self and their interaction with others and the environment. Thus one could argue that this constitutes a significant level of psychological change and hence we have another period of the development cycle.

For instance the loss of sight, hearing, memory, physical abilities and many other conditions like Parkinson's disease all require the person to make a significant psychological readjustment about how they perceive them self, their identity and how they interact with the world. Of course with illness and accidents these can occur in the adulthood stage and also result in disability and or disfigurement. Again the person has to change their perception of self and the world like happens in the Post-adulthood stage.

This model is about periods of developmental change and periods of non significant change which seems to be the task for the developmental psychologist. In the beginning of life there is a period of significant physical and psychological change. To arbitrarily break this up seems to be a nonsense. This is followed by a period of about 30 to 40 years where there is much more consistency in ones physical and psychological state such that much less psychological development and change occurs. Finally in the last couple of decades of life one again goes into a state of significant physical change. It is postulated that this would then result in significant psychological change as the person reorients their identity and perception of self to correctly align with their physical self.

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Posters Volume 5.

See volume 5 here.

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Posters Volume 4.

See volume 4 here.

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Posters Volume 3

See volume 3 here

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Sensitizing a child to an emotion (racket)

As children grow and develop they come across events where they will experience the full range of emotions. This of course is a natural thing for a child to do. However sometimes they will be hyper sensitized to an emotion which means they will feel it more often and more intensely.

This sensitizing process happens by parents encouraging that emotion in the child. For example this can happen with shame if the parents raise the child using shame. 

For example the parent may say

“You should be ashamed of yourself for...”

Or the parent in some way derides or humiliates the child in front of its peers or siblings as a means of socializing the child.

Or if the child wets the bed and the parent uses some kind of shaming process in an effort to get the child to stop wetting the bed. For example getting the child to wear its wet underpants on its head for a period of time.

If a child is raised with this then it becomes sensitized to the emotion of shame and this becomes a function on the Adapted Child ego state rather than the Free Child ego state. As children go through life they come across situations where they feel shame or embarrassment. This is Free Child. The child who is sensitized to shame will have many more situations where they feel shame than the non sensitized child. In addition when they feel the shame it will usually be more intense. This is a racket and a function of the Adapted Child ego state.

Of course this can happen with any emotion like anger, sadness, happiness and fear. When working with clients the therapist needs to diagnose if they are dealing with an FC or AC emotion as they are dealt with differently.

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Child bereavement

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Games children play - Happy to help

This game is about survival

The good child. This child does what it is told, follows the rules, can be overly

helpful, can be quite shy, is reluctant to express what it wants or needs, will put

others before itself. If they are not so much the shy one they can become high

achievers if they have natural talent in some area. They learn that to be good you do

well at school, or in sport or in civic work and so they achieve in that way, by doing

’stuff’, rather than hiding away.

Why would such a youngster exhibit excessive Conforming Child ego state and

give up their Rebellious Child and Free Child ego states?

There can be a number of reasons for this

* There can be an excessive pressure for the child to conform by the parents

who may be quite conforming themselves. “What will the neighbors think” is often

the motto of such a family. The parents are reluctant to be non-conforming

themselves and perhaps are merely parenting the way they were parented.

The pressure can also be applied because the parents use the child as a status

symbol. Often this is the eldest child in the family or the one the parents believe

have some natural talents. I recall one instance of an individual who was

relentlessly pressured by mother to go to university and become a doctor. When

ever there was a family get together it was repeatedly announced particularly by

mother that he was a doctor. She was using her sons achievement to compete or gain

credence in the wider family. You see clients like this in counselling room in their

30s or 40s and they say things like, “I never wanted to be an economist, I just

wanted to be an opera singer”.

* This can be the oldest child in the family which the parents use as a live

in baby-sitter for the younger siblings which frees up the parents. If the eldest

child accepts this role this fosters the child to put its needs behind

those of its younger siblings. Alternatively it can be a child who has a sibling who is

disabled, or sick, or has extra needs of some sort. The parents simply do not have

the time and energy to deal with the non-sick youngster so they force it to be good

so it requires less attention. In large families as well you can get the ‘forgotten

child’. In today’s culture any family that has over three children is quite possibly

emotionally damaging to the children for the reason just cited.

People who are this type of good child often will tend towards the helping

professions in adulthood. They can quite easily become transactional analysts

because in such a role you focus on the needs and wants of others and do not discuss

your own such wants. Your needs are secondary at least while you are working.

* Sometimes it is the only position left in the family. As a new child enters the

family and grows into it he has to find where he fits. The parents have the Parent

and Adult ego states covered and a sibling may have the outspoken, demanding

position taken so the ‘happy to help’ good child position is the only one left. If the

child’s natural temperament is of that kind than it can very easily fall into the good

child position in the family.

* The good child can be anxiety driven. If a child develops significant anxiety for

some reason (abuse, abandonment, threats, etc), it can make the early decision, “To

make myself safe I need to sit quietly and watch what is happening” or, “I must not

rock the boat or bad things happen”. This is an unfortunate child as it can suffer quite bad anxiety or depression but it never gets identified or diagnosed. As it does not cause problems at school or at home the adults around it will focus on other problem children and it is left unattended.

The ‘Happy to help’ game in essence involves a contraction of the Free

Child(FC) ego state. As mentioned before such game players often present for

counselling in their 30s or 40s and ask the question, “Who am I?” in some form.

Without good access to the Free Child one cannot answer that question. If you are

high Conforming Child (CC) the answer to that question is - “I am who you want me

to be”. If the person if high Rebellious Child (RC) they answer - “I am the

opposite of who you want me to be”. Both the RC and CC are adaptations to the

parents. If they are left to do what they want then they are lost, they do not have

a sense of who they are and thus will not have a direction in life and will never find

their true passion in life. The person with good access to their FC will be able to

answer the question, “Who am I?”. They can answer that with the practicalities of

life, but they will also have a sense of who they are. They will feel it inside. The RC

and CC do not feel it. The good child will struggle with this problem.

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The development of personality types

Deb from facebook asks if the anti social personality is created as a defence mechanism.

Generally speaking most would see that to be the case along with all 10 personality types listed here in addition to the core belief of each one.

Most theories would say that as the child grows it makes decisions about life. It picks up stories it liked as child and uses these to create a template (or life script) about how to live and what life is going to be like for them. This would tend to be mainstream thinking on the subject and thus would tend to agree with the assertion which Deb makes. The child picks the particular personality type as a way of adapting or defending against what it sees as adverse circumstances in childhood. All children get stressed and suffer varying degrees of trauma. It is in these times especially that they choose which defence they will have and some of those are listed in the diagram above.

I however would suggest there is an exception to this and that is the narcissistic personality and to a lesser degree the anti social personality type. With all the other types the child grows into them as a defence but with these two it is different. Instead the child never grows out of them.

All children are born narcissistic and to a lesser extent anti social. Freud called this primary narcissism. All children are born completely narcissistic and the goal is to grow out of that narcissism. Thus one could say that the adult who has a narcissistic personality never achieved this. He didn’t grow into the narcissistic personality type as a defence instead he just never grew out of it. In this way the narcissistic personality type is unique amongst all the other personality types.

Back to the original point about the anti social. It is somewhat similar in this way to the narcissist but to a lesser degree. For instance many anti socials have very little empathy for others. All children are born with no empathy. They are out for number 1 and if others suffer along the way then so be it. People acquire the skill of empathy later in life. They have to grow into it. The anti social personality never does this. They do not grow into a lack of empathy as a way of coping instead they just never grew out of a lack of empathy like most others do.

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Developmental stages of adulthood

I am currently reading a book by Jay Haley about the work of Milton Erikson. It’s a summation of the work of Erikson. Haley was probably trained in psychoanalysis because in his writing there are a number of references to how it is not necessary look at the past, what a therapist deals with is what the client presents now. There is a flavor of rebellion against the psychoanalytic approach in this way.

This leaves one with a telling question: if you don’t go back to the past of the person what do you do? He suggests a short term, here and now approach that is family therapy oriented. 

However one thing I have discovered that was somewhat insightful for me, is one of the greats of family therapy - Milton H. Erikson - rarely saw the whole family together. What he did see was various family members alone or in various combinations separately.

This is what I have done over the years even though I never considered myself a true family therapist because I rarely saw the whole family together. Now I discover to do family therapy you do not actually have to see all the family together. In my book working with drug and alcohol users I spend significant time discussing therapy with the teenage drug user and this is exactly the approach I describe when I work with them. You see any person in the family who becomes relevant to the issue at hand and in any combination that is relevant.

Family therapy

In essence I am doing family therapy but I certainly diverge from Erikson and Haley in that I will and regularly do delve into the past and individual psychology of the various parties. However this ‘discovery’ has solved another problem for me as well.

Some counsellors have a rule that if you see a couple then you cannot see either party  in individual counselling. Or if you see an individual then you cannot also start seeing them and their partner for couples counselling. I (along with other therapists I may add)  have never adhered to this view but some can get quite hot under the collar about it all and start saying things like it is unethical and so forth.

Well know I have theoretical back up for it all. I am doing family therapy Milton H. Erikson style, which is true, I am.

Body dysmorphia

However I have digressed from the point at hand

When working with an adult client at some point I always ask myself the question -why now? Why has the client sought psychological help now and why not 5 years before or in 5 years time? If there has not been a specific event that has resulted in the client attending counselling why has the client appeared now? The answer to it can of course be related to developmental psychology. The person has reached a particular developmental stage in the human life cycle and it is causing difficulties for them.

Developmental psychology

There has been a huge amount written on this area with a prime example being Freud. This chart summaries Freud’s theory of the psychosexual genesis

It shows the different developmental stages a child goes through and isolates the the developmental tasks it has to master. Most notably the oral, anal and phallic stages. Although the latency, eurethral and genital stages are added here most of the emphasis is on the pre latency stages. As a child goes through each of the stages they effect its personality development and the person becomes who they are. We all get fixed to some degree in the oral, anal and phallic stages.

The two charts below show what can happen if a person is fixated at the oral stage of development. It is divided into the oral sucking and oral biting stages. If unsuccessfully mastered the person can develop things like eating disorders or addictions especially an addiction to cigarettes.

***

In the second chart the top two rows relate to oral sucking and the bottom two rows relate to oral biting.

Whilst this is all good and well it only relates to childhood. In one way this is logical as it is during that stage that we develop the basis of our personalty. By adulthood most theories of child development agree that the personality is formed and in most instances after that time little extra change occurs.

However that does not mean there are not subsequent stages of development to master. Just like the child has to master the oral and anal stages of development the adult also has to successfully move through various stages. Thus we have the following equations

Childhood stages = master the stage and major impact on personality formation

Adulthood stages = master the stage and minor impact on personality formation

Throughout history these adult stages of development have been the poor cousin in developmental psychology. Not much has been said about them and they are by and large ignored or at least viewed as much less important than the childhood stages of development.

When adult stages have been discussed people often gravitate to the theories of Erik Erikson (No he wasn’t Milton’s brother!). A summary of Erik Erikson’s theory of development called the eight ages of man, is illustrated below

As one can see it covers the whole life span from birth until the end of life in old age.   The last three are the adulthood stages of development. He saw each stage as being a ‘battle’ between two possible outcomes. For instance in the stage he calls Adulthood he sees the goal for the individual to develop generativity versus a state of stagnation. 

In generativity the adult person seeks to establish and guide the next generation including things like productivity and creativity. He says in this way the mature person is dependent on the younger generation. The adult person needs to be needed and this need can be satisfied by guiding the young. If this is not achieved then the adult person will suffer a pervading sense of stagnation and personal impoverishment.

I find this a reasonably good statement but to me it lacks substance. It would be good for the adult person to become a guide and teacher for the young but is that it! Is that the one and only developmental task the adult person is meant to master? And from a therapeutic point of view, if one has a client who is 40 years old how is this idea of generativity vs stagnation meant to help. To me it is too esoteric in this way.

There needs to be more and by and large developmental psychology has failed in this way. Hence I arrive at Milton Erikson and Haley and what they developed. As mentioned before they refused to delve into the past unlike the majority of developmental psychology and therapeutic approaches. In my view this was a counter reaction away form the psychoanalytic philosophy of Freud.

I stated before, “if you don’t go back to the past of the person what do you do?”

As a result of this philosophy they were forced to construct a developmental theory of adulthood that was based on a behavioral understanding or focus. They developed a therapy that was short term solution focused, oriented primarily to behavioral change in how the family members related to each other.

This theory came from a clinical therapeutic basis, meaning it will tend to be readily applicable in the therapeutic setting unlike Erik Erikson’s theory. As this evolved out of their own experience with clients it meant it was their observations of a large number of clients. They were starting to identify where people tended to have problems as they moved through their adulthood. They were identifying the times (or stages) when adults had to master new tasks as a result of their increasing age.

But they kind of did it back to front. Instead of saying OK a child has to learn how to breast feed successfully whilst relating to mother, therefore the first developmental stage is the oral stage. If it does not successfully master this then the problems it will have are....

In this case they were identifying the developmental stage first which then subsequently led to the formulation of the problems relevant to that stage.

Instead Milton Erikson and Haley said, “I observe that children who present with problems seem to have difficulty leaving the parents and the home.”

In this instance first they identified the problem which subsequently led to the formulation of the developmental stage

In essence they came up with a developmental theory of adulthood by accident.

Adulthood developmental stages

The courtship period developmental task - establish a long term relationship with a mate.

Being a social person as an adult developmental task - establishing a social world external to the family of origin and some what external to the mate.

Getting married developmental task - make the decision to enter into a marriage type relationship.

Dealing with childbirth and young children developmental task - coping with and mastering the difficulties of raising young children

The middle years of marriage developmental task - between 5 to 15 years of marriage when divorce tends to happen due to the change in perception of marriage by one or both parties.

Parents letting children leave home developmental task - parents being able to wean self off children and let them move away.

Resolving the movement into old age developmental task - mastering coping with changes in the body and accepting death as a matter of course.

An interesting collection of stages that are directly applicable in counselling. If a 25 year old female presents with agoraphobia the question must be asked, “Is she successfully mastering the courtship stage developmental stage”? As I have said before sometimes it’s clear that family dynamics are involved and at other times they are just not relevant and then one moves to an individual past oriented approach to the counselling.

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Counselling and the emotion of love - Part 3

Love as a contact emotion

Love is considered one of the contact emotions with the other one being anger but it works in the opposite way. These two emotions are often, although not always, associated with contact between at least two people. Feelings like sadness and scare are not so much related to human contact.

One can feel scared about jumping off a high ledge into water, or one can feel sad about the death of one’s dog. These do not involve any interaction between two people like anger and love can. Obviously love is all about two people reacting to each other and it is an emotion that often results in two people feeling a psychological connection and indeed often spending time physically together. Anger is also about human contact where two people hit up against each other in some way. When two people are angry at each other they are in psychological contact which is also the same for love.

Love and attachment

Love and attachment are inextricably linked psychological processes. They result from each other and result in the development of each other. Love causes an increase in attachment and attachment can result in an increase in feelings of love. 

Attachment here is referring to human attachment as was originally described by John Bowlby. In the therapeutic relationship, attachment is seen to develop between client and therapist in the positive transference stage (and break down in the negative transference stage). The same applies for relationships in the non therapeutic setting. When a couple meet in a romantic sense they may develop feelings of love for each other, especially in the honeymoon stage of a relationship. When this happens the psychological attachment between them grows quickly, which can then lead to a deeper sense of love and so forth. By the end of the honeymoon period usually quite a deep level of psychological attachment has been established. This is under normal circumstances but does not happen so much with particular personalty types most notably the antisocial and the narcissistic.

The key feature of an attachment is the desire to maintain proximity. Once an attachment has been formed both parties will have a strong desire to maintain geographical proximity to the other. Also the degree of grief reaction to the loss of the ability to maintain proximity can also show the extent of the attachment. The deeper the grief at the loss of the other (through death or divorce) the stronger the attachment is/was.

From this one can deduce that should a person have difficulty with the experience of love then their attachments will be weaker than one would normally expect. This relates back to the personality types of antisocial and narcissistic who do have difficulty with the feeling of love towards another. 

However it is not only limited to them. For example I talked in a previous post about that person who has difficulty letting go of their Adult thinking and Parent controls. They also will have more trouble with the feeling of love and thus the attachment process. This typically occurs more in males than in females. Then there is the person who has suffered a broken heart in the past and all the pain that can go along with that, and they may develop some level of commitment phobia. The past experience of loss frightens them because it was so painful and hence the Free Child will naturally be more hesitant to let love feelings develop again because it knows that results in attachment and therefore one is again vulnerable to the pain of a broken heart.

There has also been an evolutionary argument put forward for this relationship between love and attachment. In cave man days when a woman got pregnant she was putting herself in a life threatening situation for herself and the child, more so than she is in this day and age of westernized societies. 

The child (and woman) has a much better chance of surviving pregnancy, birth and the post pregnancy period if there are others around to help her. To assist her with obtaining food, warding of mammoths and sabre tooth tigers and looking after the child in general. If some kind of affectionate love feelings develop in the man to the woman then he will develop a form of attachment to her. If that happens then he will have a desire to maintain proximity to the mother (and child) and hence the child has a better chance of survival. It is harder for the male to simply get up and move away from the woman. Hence the process of 

love > attachment > desire to maintain proximity 

can be seen to have a direct evolutionary advantage. Whether all this is true or not is another matter but it is an interesting hypothesis.

Therapeutic model for working with love 

1. Assess how the client understands love  - Adult or Child
2.Can client master the process of falling in love. Are they able to decommission the Parent and Adult ego states and let the Free Child be uncontrolled.
3.Those who have difficulty experiencing love may be stroked deprived as they lack the human contact that it provides. This may be reduced by having more human contact through anger.
4.The ability of the client to form an attachment can be seen as related to their ability to experience love towards another. This can identify some of those who have attachment formation difficulties.

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Magical thinking & the obsessive compulsive personality type

The person believes his thoughts, words or actions will in some way cause a specific outcome that defies the normal laws of cause and effect. For example a man believes that if he prays three time at night that will prevent his mother from dying. A woman believes that if she checks the doors three times at night then she will be safe.

Magical thinking may be part of ideas of reference or may reach delusional proportions when the individual maintains a firm conviction about the belief despite clear evidence to the contrary. Magical thinking is found normally in children and with the OC personality type.

Magical thinking is a battle between the grown up Adult ego state (A2) and the Adult ego state in the Child ego state (A1) sometimes known as the Little Professor ego state. The young child is born without an A2 ego state, all it has is its Child ego state.



Thus all the thinking it does is via the A1 or Little Professor ego state which means it will at times have quite illogical thoughts and come to quite bizarre conclusions and decisions. The Adult (A2) is not really fully formed until adolescence. Jean Piaget’s theory of cognitive development has shown this. For example it is not until the age of about 8 years that a child finally realizes that death is not reversible. Up to that time it thinks death is a reversible process. This clearly is magical thinking and thus would be seen as a function of the A1 ego state not the A2.

Most grownups eventually form a strong A2 ego state and thus go through life without odd thoughts and beliefs about the facts of the world. However we never loose the A1 ego state, it remains with us until the day we die. So all grownups have the ability to have child like magical thinking.

Superstition is a good example of this. We all know that touching wood will not make good luck befall on us, however we all touch the wood anyway, (just in case). The same for black cats and walking under ladders. Most of us do not believe it has any effect but we avoid walking under ladders, (just in case).

However the magical thinking we all have is sometimes not so banal. People can at times spend significant sums of money based on magical thinking. Some beauty treatments have no scientific basis for them but people will spend significant money on them because they believe them to work. Some skin treatments and mud packs are of this kind. Conspiracy theories may also involve magical thinking that is not logical. Some believe that Lady Diana of the UK was either killed by MI5 or the egyptian mafia rather than her simply dying in a motor vehicle accident. Magical thinking is particularly susceptible to the phenomena of group think.



In group think people start to believe the same illogical thing, because others around them believe the same thing which makes them more secure that their thinking must be true. When conspiracy theorists get together to discuss their theories, they find others have the same magical thinking which makes it more true in their minds. “The end is nigh” groups can also be of this kind, where a group of people have the same magical thinking. Because others around them believe the same that makes it more true in the mind of each individual. The phenomena of group think can particularly happen with magical thinking.

Every “The end is nigh” group has been wrong so far (but beware the next one may be true!). Often they have an elaborate belief system about why the end is nigh that is based on significant evidence which they can produce or explain how it works. The point being that significant thinking has been engaged in before the conclusion that the end is nigh is reached. It is not simply based on a whim or a hunch.



Magical thinking is be no means solely for the neurotic and the disturbed. We all can and do engage in magical thinking because we all have that ego state in our personality. Many normal good members of society can have significant areas in their life that are based on magical thinking.

However the OC personality type in particular uses magical thinking especially with compulsive behaviors and it shows how the A1 and A2 can coexist at the same time in the personality. A client recently reported to me an elaborate ritual on checking if a door was locked. He would check the door could not be opened by trying to turn the knob to open the door. He would then walk to the other side of the room, turn around, look at the knob walk back to it and try it again. He did this three times and then he felt satisfied it was locked.

He knew clearly in his Adult ego state how illogical this was which caused him even more distress. However if he did not do the ritual he knew he would feel considerable disquiet and would have this constant urge to finally complete the ritual. The magical thinking was that if the ritual was performed then he could be sure the door was locked. His A1 was stronger in the personality than the A2 with regards to this specific piece of behavior.


OC personality type - cleanliness, perfectionism, orderliness, control.



Obsessive thoughts may also involve magical thinking. A long term client recently attended an appointment in great distress. The local council that morning sprayed herbicide along the street outside her house to kill weeds on the side of the road. She was convinced that could have been contaminated by the poisonous spray before she had time to close all the windows and that she will become quite ill and possibly die.

The fact that the council has been doing this for the last 20 years and no one before had ever reported getting ill had little effect. The fact that there was no wind and the sprayers are very close to the ground had little effect to reduce her angst. The fact the government health standards make sure there is no way such herbicides sprayed the way they are would ever contaminate anyone also had little effect for her.

Her Adult (A2) acknowledged all these as true but still she felt great distress about being contaminated because there was still a possibility that it could have somehow (magically) occurred. The A1 thinking dominated the A2 in this instance and she thought about it obsessively over the next week. Such A1 based contamination fears are common in the OC personality type.


OC - pro ana


Obsessive/compulsive
I have to feel in control of life and myself so I will be orderly and perfectionistic
Drivers: Be perfect, Be strong
Injunctions: Don’t enjoy, Don’t get your needs met, Don’t be a child
Life position: I-U+
Strokes given out: Positive conditional

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Developing a treatment plan - part 2

I have spent the last few days working with clients. In that time I have consciously listened to the thinking in my head that I do about clients. Thinking I would normally do but not really been aware of. I have been listening to the thinking I do about formulating a treatment plan.

In the previous post I talked about micro issues and macro issues. This of course leads to micro counselling approaches and macro counselling approaches. I have tried to conceptualize this diagrammatically as such.



This diagram shows that the personality rests on a few basic structures. As a young child develops it will establish a few core personality structures and this can be seen to form the basic character of the child. This of course will be a combination of the child’s natural temperament plus the early decisions it makes from the Little Professor ego state (A1 ego state).

The term treatment plan as used here is that plan which addresses the core personality structures of the client. This will identify the overall direction the client can go in therapy and this is shown as the macro counselling approach. Macro counselling addresses these core structures directly. Micro counselling does not focus on nor address the core structures, instead it will address the personality features which rest upon the basic core structures.

Micro counselling is the vast majority of activity that occurs in counselling. Macro counselling is not so much what therapist does and are not the techniques employed but it is how the therapist goes about what he does or the basic parameters the therapist imposes on the therapy.



As I said before I have listened to my thinking in the past few days as I developed an understanding of the core personality structures in the client and then how I go about devising the macro counselling approaches.

The first thing I noticed was there was not much of a plan to how I went about this. Instead my thinking was quite haphazard as I discovered the core structures. What ever the client happened to be talking about defined what I thought in my formulations. The ones I thought of are added to the list I started to construct in the previous post.

Personality types - I use these a lot.
Fixated developmental stage
Current developmental stage
Attachment style
Compulsion to either thinking, feeling or behaviour
Primal reaction of flight, fight or freeze.
Behaviour patterns that have been consistent through childhood, adolescence and adulthood.
Six basic temperament features formulated in the New York study
(I am sure there are more and I do not fully understand the nature of the list I am creating here)

Of particular interest is when a client becomes highly regressed in therapy. This is when one will see the core personality structures being displayed. The more regressed a client becomes the more they will resort to their primal ways of problem solving. If a client’s primal response to stress is flight one will see this expressed more openly when they are in a highly regressed state.



Below is a list of some of the core decisions of the personality types. Much more is involved in the personality types but this does provide some of the core structures one would find in the different personality types.

Paranoid - The world is hostile so don’t trust anyone and deal with people by being angry and attacking

Schizoid - The world is scary so withdraw from it (people) and don’t show any of your feelings

Schizotypal - The world is scary so withdraw from it (people) and don’t think clearly by being a bit crazy

Antisocial - You can’t trust anyone & life’s unfair so take advantage of people and do what you like

Borderline - Relationships & life are very unreliable so frantically do anything to keep people around

Histrionic - I must be the centre of attention so I will be dramatic, flirtatious and highly emotional

Narcissistic - I have always been told that I am very important and the best so I will behave and feel like that

Avoidant - Life is scary and rejecting so I will withdraw and feel worthless

Dependent - I can’t cope with life and am worthless so I will cling to others and do what they tell me

Obsessive/compulsive - I have to feel in control of life and myself so I will be orderly and perfectionistic



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Developing a treatment plan

(This post is definitely a work in progress)

I was talking with a supervisee two days ago about psychotherapy as one tends to do! Somehow the topic of treatment plans came up. A treatment plan is a plan that is formulated by the therapist which provides the therapist (and client) with the overall direction of therapy. It identifies the general direction the client needs to go.

When a client presents at a session usually they have some matter they wish to address. This can be seen as a micro issue. This is different to the treatment plan which is a much more global understanding of the client and their psychology. One deals with the micro issue presented by the client but it is seen to form only one part of the overall marco issue or the treatment plan. Whilst dealing with the micro issue the therapist does this in the context of the overall treatment plan. It’s like the therapist has the treatment plan always in the back of his mind and all discussions are done within the context of that plan.


Don't get lost in the micro issue




My supervisee then asked how one formulates such a plan and I was a bit flummoxed by the question. I did not have an answer and it seems I had never been asked that question before.

I presented a few responses as I thought on my feet at the time and have subsequently given it more deliberation. Again I find myself doing something in therapy that I did not know I was doing. I can not recall ever reading about such a thing. All I know is that in my early days as a psychotherapist in various training groups we always talked about treatment plans but I can not recall ever talking about their formulation, which seems a bit odd now. Maybe we did and I just cannot remember.

What I came up with was a short list of things which I consider when developing a treatment plan. I suspect this is by no means a complete list.

Client core issues versus secondary presenting issues - characterological structures of the personality.

Personality types - this relates to the core issues.

Fixated developmental stage

Current developmental stage




I will certainly muse on this some more as it is an important idea for therapists and I am intrigued by the fact that as a young therapist we used to often talk about treatment plans but one hears them not mentioned much at all these days.

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Interviewing the child - Part 2

In the previous post Kahless says

I have never drunk a cup of coffee in my life I dont have the inclination, though i do wonder if it is because as a kid, i distinctly remember my brother telling me i dont like coffee. powerful stuff eh!

This is exactly the next point I was going to make. In the previous post I referred to the idea of the leading question. One can also make a ‘leading statement’ as it could be called. Doing such a thing in interviewing a child can be positive or negative depending on the circumstances.

Children are more suggestible than adults because their Adult ego state is in a rudimentary form. As a result when an adult says something to a child it will accept it more freely than would an adult. The child cannot do the critical analysis or factual assessment of what is being said as effectively as an adult can.



Consider this clinical situation:

A child reports that it has a pet fish which it loved very much. The previous day the cat climbed up on the aquarium, managed to snare the fish and eat it.

The child psychotherapist then says: “Oh, that is sad for you”.

This is a leading statement as it defines reality for the child.

Loss of loved fish = sad feelings

However the child may not be feeling that at all. At that point the child may be feeling anger at the cat and not sadness at the loss.

This can be a bad thing as it may lead to confusion in the child. As the child is highly suggestible it will take on the ‘facts’ provided by the counsellor much more readily. After hearing the counsellor’s comment the child may think,

“I thought what I was feeling was anger but it must sadness as I was told it was”. This can result in the child becoming confused about what is anger and what is sadness. The leading statement has resulted in a problem. The counsellor at least initially needed to ask a question, rather than make a leading statement. For example, “What are you feeling about what happened to your fish?”



In another circumstance one may be counselling a child for anger management. The child who tends to be chronically angry. After some inquiry one discovers that the young boy has learnt that sad feelings are bad things and result in bad consequences. He may have been humiliated by his father when he cried at home. What he does is cover up his sad feelings with anger which is acceptable to his father. The problem is his sad feelings are never resolved and hence he ends up being chronically angry.

Thus the counsellor can make ‘suggestions’ to the child with leading comments such as, “People feel sad when their pet dies”. As they are more suggestible the child will take this comment on more so than an adult would. Such a statement gets planted deeper in the psyche of the youngster than the adult. In this case their suggestibility is being used for therapeutic advantage. (Of course one also makes sure there is not confusion about anger and sadness). The suggestion has affirmed that sad feelings exist, that the child does have sad feelings and that such feelings are appropriate at times



The key to such suggestions is for the counsellor to get the relationship with the child right first, get their timing right and deliver it in a way that will have the most impact.

Hence we get back to the comment by Kahless

I have never drunk a cup of coffee in my life I dont have the inclination, though i do wonder if it is because as a kid, i distinctly remember my brother telling me i dont like coffee. powerful stuff eh!
---------

It is possible this was a suggestion inadvertently given by her brother. The circumstances were right at the time when he made the suggestion and she took it on as a fact. When that happens it is powerful stuff indeed my pommy friend!

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Childhood mental health problems

Most common mental health issues encountered in 6 to 12 year olds
Reported by school psychologists

Anxiety - 73.1%
Challenging behaviour - 71.8%
Family/parenting concerns - 65.4%
Peer relationships - 59%
Anger and conflict - 55.8%
Bullying - 41.7%
Self esteem - 38.5%
Child safety and protection - 31%
Depression - 21.1%
Trauma - 19.2%

Challenging behaviour = Autism spectrum disorder, ADHD, oppositional disorder, learning difficulties and conduct disorder

Ref: [Inpsych - Bulletin of the Australian Psychological Society, June 2011]



My work with children has mainly been in the private practice setting. Children are brought to me by their parents usually. The list cited above would be quite similar to how I would rate the children I have seen over the years.

One thing that has always interested me in my work with children, and what this data supports, is the low rate of depression as compared to the other mental health problems presented. I have found this surprising as I expected it to be higher. I expected anxiety to be as high as it is but I also expected depression to be the same. Which it is not. The rate of depression is much lower.

Why I expected this is because with adults and adolescents they tend to be about the same.

Adults in Australia (Department of health and ageing statistics)
10% anxiety at some point in adult life
20% depression (6% major depression)

One needs to be careful with such statistics as they can vary quite considerably depending on how one defines depression and anxiety. However, it seems safe to say that in adults there are similar amounts of depression compared to anxiety unlike in childhood. They are at similar rates whereas in childhood that is not the case with anxiety being much more prevalent than depression. According to the research above anxiety is three to four times more prevalent than depression in children seeking help from school psychologists.



This of courses raises the question as to why this would be so. I don’t know of any explanation that has been given to answer this question. So I thought I might do some hypothesising of my own.

Anxiety in childhood
It could be that diagnosing depression in children is harder than in adults. Thus the rates of depression are higher in children but are not recognised because the children do not present to school psychologists with that difficulty. I suppose this could be the case but it seems a bit dodgy to me as depression is not that hard to diagnose. Even if the child does not report the problem emotions found in depression the body language of a depressed child is not that hard to detect. It would also seem reasonable that a depressed child is just as likely to report unpleasant emotions as an anxious child. Why should there be any difference between those two?

It seems more reasonable to me that childhood by its very nature is more likely to produce reactions of anxiety rather than depression, whereas in adulthood this is not the case. It is simply a matter of when god made us, she stuffed up. The way humans reproduce the species is by giving birth to very small versions of adults that take almost two decades to fully mature.

As adults it is easy to forget just how vulnerable a child is. A child is like living in the land of the giants. Take a minute to lie face up on the floor, get someone to stand over you and remind yourself of how a child sees her relationships with adults.




One of my favourite TV shows in childhood - Land of the giants.

This could partly explain why anxiety is the highest of all mental health issues in childhood. A child’s life is on the line each day. Its actual physical existence is out of its control and is determined by those adults around her. Indeed a threatening state of affairs even if the child is treated well. Those around it can kill it at any time and of course children don’t understand about laws against murder and so forth until much later in life.

It has been postulated that you can roughly determine the difference in strength between two people by taking the fourth power of the ratio of their heights.
Ref: [S. Gould. 1977. Ever Since Darwin. New York: W.W. Norton Company.]

The height of the average female is twice that of the average two year old so she is (24 = 16) sixteen times stronger than the child (2 to the power of 4). A very large difference in power and strength I think one could say. It has been postulated that around that age of 10 - 12 years is the first time where a child could probably start to look after itself in terms of acquiring the food and shelter necessary to live. Up until that time the child’s physical well being in terms of food and shelter is dependent on the adults around it. Of course the child knows that the adults can withdraw that food and shelter should they choose to do so.



Despite these physical threats we also have all the psychological causes of anxiety. If a child is psychologically abandoned in some way, which many are to varying degrees, anxiety is a common reaction to such abandonment. Children are much more psychologically dependent on those around them than adults are and thus anxiety may be more prevalent in childhood as a result.

Every parent also has a Child ego state of their own. Sooner or later there are going to be situations where their own Child ego state needs are going to take priority over the needs of their biological child. A classic example is post natal depression. In this case the mother’s own Child ego state needs may be to sleep for extended periods of time in bed as a consequence of the depression. When she does this her biological children’s psychological needs are secondary and thus anxiety can result when the children experience this psychological abandonment.

Finally normal human development requires the child to master scary developmental tasks. Most obviously the separations from mother and father. Such as going to school, handling difficult circumstances without mother’s help, getting a job and just becoming psychologically independent is an anxiety producing process.



There we have it. This could explain to some degree why childhood is more of an anxiety producing stage of human development as compared to adulthood. It does not seem possible to develop an argument for why childhood would be a more depression producing stage of development. Indeed the level of depression in childhood in the first piece of research cited put it at 21%. The statistics from the Department of health and ageing put the level of depression in adulthood at 20%. They are the same. Whereas anxiety in children seeking help was around 70% and in adulthood put around 10% of adults in general.

Nothing like a bit of hypothesising on a Friday!

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Sexual dysfunction (Part 3)

In this third part of the series on sex and sex counselling I arrive at what was the original motivation for addressing this area in the first place. I have been working recently with a man who presents with the problem of premature ejaculation (PE). This is not an uncommon problem to come across as a counsellor however in this instance there are a few noticeable differences.

In this case it was the main up front presenting problem which he sought counselling for. Most often PE will arise as a kind of side issue raised by the man a few weeks or months after counselling has commenced. This may be because he is embarrassed about it and hence procrastinated about bringing it up or it may be that it is seen as less of a problem. In this case it was brought up near the end of the first session after much struggle. He was clearly distressed by it much more so than one usually finds.



To my mind the whole area of PE is a dodgy one. It is included in the mainstream literature on abnormal states. Indeed the DSM-IV has it there included with all the other sexual dysfuctions. However unlike some of the other dysfunctions listed it is based on an assumption. The assumption that good, correct, normal, psychologically OK sex has to involve intercourse. This need not be so at all. Emotionally and physically satisfying sexual contact between two consenting adult does not have to involve intercourse.

So why does this assumption exist? I can think of three possible reasons.
1. Biologically the reason for having sexual contact is for procreation and thus intercourse is required.
2. Historically religion has had some clear views on the purpose of sexual contact and the sin that comes from simple pleasure of the flesh.
3. Historically psychologists have defined healthy sex in such a way that intercourse is required. Sex without intercourse has historically been defined as a psychologically abnormal act. Now it becomes clear why I wrote the previous post - Sexual repression (Part 1) - where I address this precise point.



In the DSM-IV the diagnostic criteria for PE includes two points.
1. Ejaculation after minimal stimulation and before the person wishes it

PLUS

2. Marked distress caused by this.

Thus the DSM is at least partly agreeing with the point I am raising here. The premature ejaculation itself is not considered a problem. It must also be accompanied by psychological distress.

That distress will be caused sometimes because of the assumption I have just described. If one removes the assumption there is not going to be so much distress if any at all.

The problem I have with the DSM-IV and hopefully this will be changed in the DSM-5 is the title of the disorder. It is titled - Premature ejaculation - which is a misnomer. This title implies that it is simply the premature ejaculation that is the problem regardless of the distress or lack of it. It would be more aptly named, ego dystonic premature ejaculation. This is more accurate and would also help people like my client when they come across statements about abnormal psychology such as found in the DSM.



The suggested title comes from the DSM-III. This book published in 1980 included the category, ego dystonic homosexuality. As late as the 1970s homosexuality was still considered an abnormal psychological state in the mainstream literature. In its efforts to extract homosexuality from the pages of the texts on abnormal states the DSM chose this interim measure and coined the condition - ego dystonic homosexuality. By the time the DSM-IV arrived in 1994 even that had disappeared and mainstream literature no longer viewed homosexuality as an abnormal state.

Treatment
Back to the point at hand about PE. The manuals on the treatment of PE invariably focus on behavioural methods such as the stop and squeeze technique. Whilst certainly useful in some cases, I also suggest working on the assumption the man has in his Parent ego state, that ‘proper’ sexual contact must include intercourse. I cannot recall ever seeing such a proposal in a PE treatment manual. If the Parent ego state belief about ‘proper’ sex can be altered this can significantly disempower the PE problem in the man’s mind,. If that occurs then any technique like the stop and squeeze method is more likely to be successful and even if it isn’t that doesn’t matter anyway.

Thus we have addressed the behavioural treatment and changing the Parent ego state assumption about ‘proper’ sex. Also often apparent is some kind of Child ego state decision. With my client this was the case. His distress was based on his Child belief that the PE meant he could not function properly as a male. Thus it brought his sense of his maleness into question and this was what was so distressing for him.



There can be many other Child ego state beliefs related to the PE. There may have have been some kind of sexual assault on him as a child or ridicule by his peers that related to sexual matters when engaged in sex play and experimentation as a child. Indeed sometimes PE is an aggressive act against the woman - “I am going to satisfy myself and not you”.

However despite all this, if one chooses not to accept the assumption aforementioned then PE as a problem ceases to exist.

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